2024-25 Plan Year
Available Medical Plans (Both Networks available on all plans)
Medical Premiums
| Traditional | Value | STAR (QHDHP) | |
| Deductible PPY Individual/Family |
$1,500 / $4,500 | $2,250 / $6,750 | $2,000 / $4,000 *Based on how you are enrolled |
| Out of Pocket Maximum Individual/Family |
$5,000 / $10,000 | $5,000 / $10,000 | $5,000 / $10,000 |
| Coinsurance | 80% / 20% AD | 80% / 20% AD | 80% / 20% AD |
| Visit Co-Pays Primary / Specialist / Urgent Care |
$40 / $50 / $60 | $35 / $45 / $55 | 80% / 20% AD |
| Preventive | Covered 100% | Covered 100% | Covered 100% |
| Prescriptions Generic / Preferred / Non-Preferred / Specialty Mail in Order 90 Day Supply |
$25 / 35% / 50% / 50% $50 Generic |
$250 Deductible Per Person then $15 / 25% / 35% / 35% $30 Generic |
80% / 20% AD |
For more details, see plan summary:
Advantage/Summit Traditional Plan
Advantage/Summit Value Plan
Advantage/Summit STAR Plan
Networks
Summit (generally non-Intermountain Health providers & rural Intermountain hospitals.)
University of Utah Ogden Regional
St. Marks Huntsman Cancer Institute
Lone Peak Hospital Holy Cross Hospital - Jordan Valley (Jordan Valley Hospital)
Primary Children's Holy Cross Hospital - Salt Lake (Salt Lake Regional)
Advantage (generally uses providers largely around Intermountain Health facilities)
Intermountain Medical Center McKay Dee
LDS Hospital Riverton
Alta View American Fork
Primary Children's
Please see herefor a complete network list of hospitals.
If you have dependents living out of state, you need to contact PEHP to let
them know prior to receiving medical care for non emergencies.
PEHP Value Providers
See healthcare providers with the lowest out-of-pocket costs.
Traditional and Value Plans: $10 office co-pay
The STAR Plan: 25% discount on what you would normally pay an in-network provider
Click here to find current PEHP Value Providers!
Preventive Care
PEHP Pays for Preventive Benefits at 100%! Don’t put off that test or immunization. Preventive benefits are covered at no cost to you when you see a contracted provider — even before you meet your deductible. This applies to all of our plans - The STAR, Value and Traditional Plans. See attached list for what services count as preventive.
PEHP Preventive Care List
More information on preventive services can be found at HealthCare.Gov
You can get CASH BACK on certain procedures, testing and scans for using PEHP Value Providers, see below to learn how to get started!
PEHP Cost Tools
E-Care/ Telemedicine
Visit a doctor online anytime, anywhere.
Intermountain Connect Care is available on all networks
Intermountain Connect Care
University of Utah Health Virtual Visits available on Summit network only
University of Utah Healthcare Virtual Visits
Traditional and Value Plans: $10 per visit
STAR HSA Plan: $49 (U of U), $69 (Connect Care) per visit or $10 per visit after deductible
Need ID Cards? Print your ID Card from PEHP's website!
How to Print ID Cards from PEHP
If you use a specialty medication, you may be eligible for Express Scripts SaveOn program!
By enrolling in the available manufacturer assistance program and consenting to SaveOnSP monitoring your pharmacy account, your final cost will be as low as $0. Please call 1-800-683-1074 to participate.
SaveOn Medication List
CRX International
Get brand-name maintenance medications at huge SAVINGS.
Visit CRX International to find which prescriptions are eligible and to enroll!
WebID: JORDANSD
Who is eligible for CRX?
-Anyone on the Traditional or Value plans
-Anyone on the STAR plan who has met their deductible (proof will be required)
Forms:
PEHP Flex Spending Reimbursement Form
Prescription Reimbursement or COB Reimbursement Form
Glossary of Health Coverage and Medical Terms
2024-25 Traditional Plan Summary of Benefits & Coverage (SBC)
2024-25 Value Plan Summary of Benefits & Coverage (SBC)
2024-25 STAR (QHDHP) Plan Summary of Benefits & Coverage (SBC)
2023-24 Traditional Plan Summary of Benefits & Coverage (SBC)
2023-24 Value Plan Summary of Benefits & Coverage (SBC)
2023-24 STAR (QHDHP) Plan Summary of Benefits & Coverage (SBC)